Tissue anchoring system and method

ABSTRACT

A tissue anchoring system includes a tissue anchor affixed to an end of a cable and supported for insertion on a delivery device, the manipulation of which permits placement of the anchor on a far side of the tissue. A tensioning, crimping and cutting tool designed for use along the cable&#39;s longitudinal axis, thus reducing the number of incisions required. A suture anchoring system is also described for introducing a loop of suture into a surgical site and anchoring it, for instance, across a tear in soft tissue.

[0001] This application claims the benefit of U.S. patent applicationSer. No. 09/560,293 filed Apr. 27, 2000 which is a Divisional of U.S.patent application Ser. No. 09/013,434 filed Jan. 26, 1998 now U.S. Pat.No. 6,068,648 granted May 30, 2000.

BACKGROUND OF THE INVENTION

[0002] The present invention relates to surgical devices and methodsand, more particularly, to devices and methods for the repair of boneand soft tissue.

[0003] It is a common requirement in orthopedic surgical procedures toanchor two or more elements together, such as pieces of a bone, two orbones, or a combination of soft tissue and bone. This has beenaccomplished by a number of devices, such as bone bolts that penetratetwo pieces of bone and use a nut to draw the segments together, bonescrews and interconnecting plates, wires circling at least two pieces ofbone, or sutures into the tissue.

[0004] Often such devices require a relatively large access openingthrough surrounding and/or covering tissue to implant the anchoringdevices. The enlarged access site may increase patient pain and lengthenrecovery time. Further, in some locations it is difficult andimpractical to make large access points to reach the appropriate sitebecause of surrounding joints and vessels. Even with devices thatpenetrate the tissue in a substantially linear manner, i.e. lag bolts,the fracture must often be reduced before drilling and insertion of thebolt. Further, some of these devices may be difficult to use since itmay be hard to reduce a fracture between two bone segments and maintainthat reduction while the device is inserted. This is particularly truewith small bone fragments where the use of threaded implants may tend torotate one bone segment with respect to another, thereby creating amisalignment between the fragments.

[0005] Cerclage systems provide an alternative to implants that mustpenetrate the bone to achieve fixation. Such devices have been taught byMiller et al. (U.S. Pat. No. 5,312,410) and Songer et al. (U.S. Pat. No.5,536,270). These systems rely on passing a cable around two segments ofbone and then tensioning the cable to squeeze the bone segmentstogether. A significant drawback of these systems is that they requireaccess around the entire bone.

[0006] Therefore, there remains a need for a convenient and effectivesystem for securing two segments of tissue together. Such a systemshould preferably be operable through a relatively small insertionopening or openings to securely hold two tissue segments.

SUMMARY OF THE INVENTION

[0007] An anchor system according to the present invention can comprisean elongated flexible member having a diameter, a proximal end, a distalend and a longitudinal axis; an anchor having a proximal end, a distalend, a central portion between the proximal end and the distal end and alongitudinal axis extending between the proximal end and the distal end,the anchor including a longitudinal slot extending longitudinally fromthe proximal end to the central portion, the slot having a width greaterthan the flexible member diameter, the flexible member distal endaffixed adjacent the central portion. The anchor is moveable relative tothe flexible member between a first position wherein the longitudinalaxes of the flexible member and the anchor are generally parallel with aportion of the flexible member adjacent the distal end residing withinthe slot and a second position wherein the longitudinal axes of theflexible member and the anchor are generally perpendicular.

[0008] Another embodiment of an anchoring system according to thepresent invention, comprises an elongated flexible member having aproximal end, a distal end and a first diameter; and an anchor affixedto the distal end, the-anchor moveable between an insertionconfiguration adapted for insertion through a tissue opening and ananchoring configuration adapted to inhibit passage through the tissueopening, the insertion configuration having a second diameter less thantwice the first diameter, and the anchoring configuration having a thirddiameter greater than the second diameter.

[0009] The system further includes a delivery device having a distalend, the distal end adapted to releasably receive at least the anchorproximal end for releasably retaining the anchor in the first positionfor insertion through at least a portion of a section of tissue, theanchor releasable from the delivery device for anchoring the flexiblemember in the section of tissue. The delivery device includes amechanism for releasably exerting a longitudinal force on the flexiblemember in a proximal direction, for retaining the anchor proximal end inthe delivery device and thereby in the first position.

[0010] In one embodiment, the insertion device comprises an inner tubehaving a longitudinal bore extending from a proximal end to a distalend, the inner bore sized to permit passage of an elongated flexiblemember and to prevent passage of an anchor attached to an elongatedflexible member; an outer tube having a longitudinal bore extending froma proximal end to a distal end, the outer tube bore dimensioned topermit the inner tube to pass therethrough; and a mechanism for applyingtension to an elongated flexible member, the means positioned adjacentthe distal end of the inner tube.

[0011] The system of the present invention further contemplates acrimping tool which can comprise an outer member having an inner passageand a distal end having an outer diameter. A crimping mechanism can bedisposed within the inner passage adjacent the distal end. The crimpingmechanism movable with respect to the outer member between a crimpingposition and an open position.

[0012] An alternative embodiment of the present invention includes asuture anchoring system for attaching a first section of tissue to asecond section of tissue via a unitary incision having a longitudinalaxis. The anchoring system comprises a suture anchor connected to asuture material having a first end, a second end, a longitudinal axis,and a diameter. The suture anchor has a longitudinal axis generallyextending from a proximal end to a distal end and a firstcross-sectional dimension generally along the longitudinal axis greaterthan a second cross-sectional dimension generally perpendicular to thelongitudinal axis. The system further includes a mechanism for slidablyaffixing a central portion of the suture material to the suture anchor,the first end and the second end of the suture material retainableoutside the incision. The suture anchor is pivotable relative to thesuture material between a first position wherein the longitudinal axesof the incision and the suture anchor are generally parallel and asecond position wherein the longitudinal axes of the incision and thesuture anchor are generally perpendicular.

[0013] The present invention also contemplates a bone opening protectorhaving a first portion defining an opening therein to receive a cable.The first portion is adapted to engage a surface surrounding a boneopening. The protector also includes an anchoring extension, connectedto the first portion, adapted to extend into bone to inhibit movement ofthe first portion.

[0014] The invention further contemplates a method for joining twosections of tissue. The method includes providing a first anchor, anelongated member attached to the first anchor, a second anchor slidableon the elongated member and having a deformable portion adapted toengage the elongated member, and a crimping tool having an outer memberand an inner member movably disposed within the outer member. The firstanchor is inserted into a first section of tissue. The second anchor isthreaded on the elongated member. Tension is applied on the elongatedmember to urge the first section of tissue toward a second section oftissue. The elongated member is threaded through the crimping device,and the inner member of the crimping device is moved with respect to theouter member thereby deforming the deformable portion of the secondanchor and maintaining the tension applied to the elongated member.

[0015] One object of the invention is to provide an element foranchoring tissue.

[0016] Another object is to provide a system for delivering the tissueanchoring element.

[0017] A further object is to provide such a system that also tightensand ligates the anchoring element.

[0018] An additional object of the present invention is to provide acrimping tool.

[0019] Still another object is to provide a method for delivering atissue anchoring element to a surgical site.

[0020] Yet another object is to provide an element for anchoring suturematerial.

[0021] Yet a further object is to provide a system for delivering thesuture anchoring element.

[0022] Yet an additional object is to provide a method for delivering asuture anchoring element to a surgical site.

[0023] Still a further object of the present invention is to provide abone opening protector.

[0024] Other objects and advantages of the present invention will beapparent from the following description.

BRIEF DESCRIPTION OF THE DRAWINGS

[0025]FIG. 1A is a perspective side view of the cable/anchor element ofthe present invention in an anchor position, ready to anchor tissue.

[0026]FIG. 1B is a perspective side view of the cable/anchor element ofthe present invention in an insertion position, ready for delivery bythe delivery device.

[0027]FIG. 2A is a top view of the anchor of the present invention.

[0028]FIG. 2B is a side view of the anchor of FIG. 2A.

[0029]FIG. 2C is a right side view of the anchor of FIG. 2B.

[0030]FIG. 3A is a top view of an alternative embodiment of the anchorof the present invention.

[0031]FIG. 3B is a side cross-sectional view of the anchor of FIG. 3A.

[0032]FIG. 4 is an exploded perspective view of an alternate embodimentof a delivery device according to the present invention.

[0033]FIG. 5A is a side partial cross-sectional view of the deliverydevice of FIG. 4.

[0034]FIG. 5B is a top partial cross-sectional view of the deliverydevice of FIG. 5A.

[0035]FIG. 6 is a side partial cross-sectional view of still a furtherembodiment of a delivery device according to the present invention.

[0036]FIG. 7A illustrates a suture anchor according to the presentinvention supported by a delivery device's distal end.

[0037]FIG. 7B illustrates the suture anchor of FIG. 7A being used inrepairing a soft tissue tear.

[0038]FIG. 8 illustrates the insertion step of the method of use of thesystem in anchoring a ligament to a bone.

[0039]FIG. 9 is a front perspective view of an eyelet anchor accordingto the present invention mounted on a delivery device.

[0040]FIG. 10 is a front perspective view of the eyelet anchor of FIG. 9being affixed to a bone with an attached cable extending through a boneopening protector and secured by a second anchor.

[0041]FIG. 11A is a front view of a bone opening protector according tothe present invention.

[0042]FIG. 11B is a side cross-sectional view of the bone openingprotector of FIG. 11A.

[0043] FIGS. 12 (A-E) illustrates a method of use of a system accordingto the present invention in anchoring two sections of bone together. InFIG. 12A the delivery system with anchor and attached cable are insertedthrough the bone. In FIG. 12B the anchor is pivoted. In FIG. 12C awasher and a ferrule are threaded onto the proximal end of the cable,and in FIG. 12D the ferrule is crimped onto the cable, and the cable iscut, leaving the bone fragments anchored as shown in FIG. 12E.

[0044]FIG. 13 is a perspective side view of a tensioning, crimping andcutting tool according to the present invention.

[0045]FIG. 14A is a perspective view from the distal end of thetensioning, crimping and cutting tool of FIG. 13.

[0046]FIG. 14B is a perspective cross-sectional view adjacent the distalend of the tensioning, crimping and cutting tool taken along B---B′ ofFIG. 14A.

[0047]FIG. 15A is a side cross-sectional view of an alternative cabletensioning mechanism for use with the tool of FIG. 13.

[0048]FIG. 15B is-a cross-section of the mechanism of FIG. 15A takenalong line B-B.

[0049]FIG. 16 is a side view of an alternative embodiment of atensioning, crimping and cutting tool according to the presentinvention.

[0050]FIG. 17 is a partial cross-sectional view of the tool of FIG. 15.

[0051]FIG. 18 is a top view of the tool of FIG. 15.

[0052]FIG. 19 is a front partial cross-sectional view of still a furtherembodiment of a tensioning, crimping and cutting tool according to thepresent invention.

DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0053] For the purposes of promoting an understanding of the principlesof the invention, reference will now be made to the embodimentsillustrated in the drawings and specific language will be used todescribe the same. It will nevertheless be understood that no limitationof the scope of the invention is thereby intended, such alterations andfurther modifications in the illustrated device; and such furtherapplications of the principles of the invention as illustrated thereinbeing contemplated as would normally occur to one skilled in the art towhich the invention relates.

[0054] Referring to FIG. 1A, a tissue anchoring system 10 according tothe present invention includes a cable 20 having an anchor 30 affixed toa distal end 202. A delivery device 40 is also provided for aiding ininserting the cable 20 through tissue. The term “tissue” is used hereinto include any manner of body part including without limitation, bone,cartilage, ligaments, tendons, and muscle;

[0055] Referring to FIG. 1A, cable 20 may be any elongated flexiblemember, the choice of material and size being dependent upon theparticular application. For the purposes of illustration and withoutlimitation, the flexible member is referred to and shown as a cable,although it is within the spirit of the invention that a flexible membercould similarly be a filament, thread, suture, wire, substantially flatribbon type member, or any other flexible member suitable forimplantation in the body. Cable 20 may comprise such biocompatiblematerials as stainless steel, titanium, nitinol, plastic, bioresorbablematerial, composite material, or cobalt chrome alloy. The list ofpossible cable compositions is provided for the purpose of illustrationand is not intended as limiting, it being understood that selection of acable may depend on the intended application. In a preferred embodimentfor use in bone fracture reductions, cable 20 is a flexiblemultistranded metallic cable such as stainless steel as is already knownin the art. In a system for affixing two sections of soft tissuetogether, suture material or an equivalent threadlike material can beused instead of metallic cable. Thus, it is to be assumed herein thatthe word “cable” should be taken to mean any flexible material that canbe used in surgical applications for affixing two sections of tissuetogether, and no limitations are intended thereby.

[0056] Cable Anchor

[0057] Attached to the cable's distal end 202 is a generally cylindricalanchor 30 (FIGS. 2A and 2B) that has a closed distal end 302, an openproximal end 304, and a partial bore 301 extending from the proximal end304 but not through to the distal end 302. The distal end 302 is roundedto limit damage to surrounding tissue and for ease of insertion throughthe tissue to be anchored. Anchor 30 includes a longitudinal axis 303that extends from the proximal end 304 to the distal end 302. The anchormay be constructed of a material similar to the cable or the anchor maydiffer from the cable. In one combination, the cable is non-resorbablewhile the anchor is bioresorbable such that the cable may be removedafter a healing period and the anchor may remain in the body.

[0058] The anchor 30 has a distal portion 317 having a firstcross-sectional diameter 306, or width, larger than the diameter 206 ofthe cable 20. In a preferred embodiment, diameter 306 is less than twicediameter 206, thus providing a relatively small insertion diameter. Thisfirst cross-sectional diameter 306 generally coincides with acylindrical diameter. In a preferred embodiment, diameter 306substantially equals the outer diameter of delivery device 40. A secondcross-sectional dimension 308, or length, is significantly larger thanthe width 306. This length 308 generally coincides with the length ofthe anchor 30 from proximal end 304 to distal end 302.

[0059] The anchor 30 also has a proximal portion 310 opposite the distalportion 317, the proximal portion 310 having a width 320, the proximalportion width 320 smaller than the distal portion width 306. Theproximal portion 310 includes a taper 318 tapering toward the proximalend 304 and a thickness 322. It will be understood that upon engaging asurface with cable 20 proximally tensioned, taper 318 assists the anchorin flipping to an anchoring position and in sliding under adjacenttissue during the flipping process. There is a shoulder 311 between theproximal portion 310 and the wider distal portion 317, for engaging thedistal end of the delivery device 40.

[0060] In addition, the anchor 30 has a generally longitudinal slot 314extending from the proximal end 304 into the distal portion 317. Slot314 has a width 312 equal to or greater than the cable diameter 206. Thedistal end 202 of the cable 20 is affixed, for example, via crimping,within the anchor bore 301 between the anchor's distal end 302 and theslot's distal end 315 (see FIG. 1A). In a preferred embodiment, a fourpoint crimp is applied to anchor 302 to secure cable 20 within bore 301.However, it is contemplated that an alternative crimping procedure couldbe performed as well as welding, brazing, adhesive, etc. Additionally,cable 20 may include a loop at its distal end for attachment through anaperture in the anchor. Any attachment means may be used provided thecable is secured to the anchor with sufficient strength for the intendedapplication.

[0061] In a preferred embodiment, the anchor outer diameter 306 is lessthan twice the cable diameter 206. This permits the cable and anchorcombination to be inserted through a relatively small hole or incision.However, the length 308 is much greater than the anchor diameter 306thereby providing a secure anchorage for the cable.

[0062] The anchor 30 is movable in relation to the cable 20 between twopositions: a first position (FIG. 1B) wherein the anchor's longitudinalaxis 303 is generally parallel to the cable's longitudinal axis 207 andthe cable's distal portion 201 resides within anchor slot 314, and asecond position (FIG. 1A) wherein the anchor's longitudinal axis 303 isat an angle to the cable's longitudinal axis 206 and a part of thecable's distal portion 201 extends outside anchor slot 314. Anchor 30includes a curved surface 324 adjacent slot 314 for the cable to bearagainst and limit abrasion when in the second position. By the nature ofthe cable-anchor connection, the anchor 30 is biased to the secondposition. This biasing occurs because the first position is unstable.Such biasing may be induced by a pre-set curve in distal portion 201 ofcable 20 positioned within slot 314 tending to rotate anchor 30 to thesecond position. In addition to biasing the anchor towards the secondposition, taper 318 on the proximal end of anchor 30 urges rotation ofthe anchor to the second position when it contacts a surface.

[0063]FIGS. 3A and 3B show an alternative embodiment of the anchoraccording to the present invention. The anchor 350 includes a bead 352having a bore 360 defined therein. The distal end 362 of cable 354 isreceived within the bore and bead 352 is affixed to the cable. Pivotingmember 356 includes a longitudinal slot 370 in communication with alongitudinal bore 364 extending to distal end 358. The bore 364 and slot370 are sized to slidably receive cable 354 therein. The distal end 358defines a spherical cavity for receiving a portion of bead 352. Anchor350 is pivotable from the first insertion position shown in FIGS. 3A and3B to an anchoring position as shown in FIG. 1A.

[0064] Delivery Device

[0065] The present invention further contemplates a delivery device forinsertion of a cable and anchor combination. Although the device isillustrated for use with the above described anchor, it is contemplatedthat the delivery device may be used or adapted for use with a varietyof cable and anchor combinations. A first embodiment of the deliverydevice 40 (FIGS. 1 and 2) comprises a rigid metallic cylindrical memberhaving a length 405 sufficient to penetrate a desired surgical site anda longitudinal bore 401 extending from a proximal end 404 to a distalend 402. The bore 401 is sufficiently large to permit the anchor'sproximal portion 310 to fit thereinto but too small to permit theanchor's distal portion 317 to fit thereinto. Although a preferredembodiment of the delivery device has the distal portion of anchor 30extending distally beyond the distal end of the delivery device, it iscontemplated that anchor 30 could be entirely retained within thedelivery device until it is deployed. In this embodiment (not shown),cable 20 could be fixed with respect to delivery device 40 to preventaccidental deployment of the anchor.

[0066] The cable/anchor 20/30 combination is inserted into tissue withthe aid of the delivery device 40, which is used to provide mechanicalstiffness to the cable 20. The cable's proximal end 204 is passedthrough the delivery device 40 from the distal end 402 through the bore401 to beyond the proximal end 404. The anchor's proximal portion 310 isseated in the delivery device bore 401 adjacent the distal end 402, andtension is maintained on the cable's proximal end 204 to retain theanchor 30 in the first position. Although a preferred embodiment of thedevice shows proximal end 304 held within bore 401, it is contemplatedthat proximal end 304 may include threads and delivery device 40 maysimilarly have cooperable threads on the distal end such that the devicemay be threadedly held on delivery device 40. Alternatively, there maybe a frangible connection between proximal end 304 and the distal end ofthe delivery device, the frangible connection breakable to permit anchor30 to move to the second position.

[0067] In a second embodiment of a delivery device according to thepresent invention,(FIGS. 4, 5A, and 5B), the impelling means comprisesmeans for releasably maintaining a longitudinal force on cable 20 in aproximal direction, for retaining the anchor 30 in the first position.

[0068] In this embodiment, the delivery device 70 comprises a body 72,which has a handle portion 720 having a proximal end 722 and a recess728 at the distal end 724. The recess 728, which extends from the top721 to the bottom 723 of the delivery device body 72, is rounded at itsproximal end 725. A longitudinal bore 726 extends from the proximal end722 to the distal 724 end, the bore 726 being dimensioned to permitcable 20 to pass therethrough.

[0069] A pawl housing 75 is movably affixed to the delivery devicebody's distal end 724 via its rounded proximal side 752, which isdimensioned to slide longitudinally within the delivery device body'srecess 728. The pawl housing 75 has a pawl cavity 758 that extends fromthe pawl housing's top 751 through a portion of the pawl housing. Thepawl housing 75 additionally has a longitudinal bore 756 that extendsfrom the proximal side 752 to the distal side 754 through the pawlcavity 758. The bore 756 is dimensioned to permit cable 20 to passtherethrough, and is adapted for communication with the delivery devicebody's bore 726 when the device is assembled for use. A spring bore 757extends from the distal side 754 into the pawl cavity 758 and ispositioned above the longitudinal bore 756.

[0070] The delivery device 70 further comprises an inner tube 73 that isaffixed at its proximal end 732 to the pawl housing's distal side 754.The inner tube 73 is generally cylindrical and has a longitudinal bore736 that extends from the proximal end 732 to the distal end 734 and isdimensioned to permit the cable 20 to pass therethrough but is too smallat the distal end 734 to permit the anchor's proximal portion 310 toenter. This bore 736 is in communication with the pawl housing bore 756.

[0071] Another element of the delivery device 70 is a nose assembly 74that is in mechanical communication with the pawl housing 75. Theproximal side 742 is affixed to the distal end 724 of the deliverydevice body 72 with two screws (not shown). These screws are insertedthrough first and second screw bores 782 that extend from the tapereddistal side 744 of the nose assembly 74 through to the proximal side742. First and second screw bores 782 are positioned to meet third andfourth screw bores 727 (FIG. 10B) that extend into the body 72 from thebody's distal end 724.

[0072] The nose assembly 74 has a rounded recess 748 that extends fromthe top 741 to the bottom 743 and is shaped to receive the roundeddistal side 754 of the pawl housing 75. The two recesses 748,728together define an enclosed elongated hole 79 that has a width 792dimensioned to closely and slidably engage the pawl housing 75 and alength 794 greater than the length 755 of the pawl housing 75,permitting the pawl housing 75 to slide longitudinally therein from afirst position against the recess proximal end 725 to a second positionwithin the nose assembly recess 748 (dotted line, FIG. 5B).

[0073] The nose assembly 74 further has a longitudinal bore 746 thatextends from the proximal side 742 to the distal side 744, this bore 746dimensioned and positioned to permit the inner tube 73 to passtherethrough and slide relatively thereto.

[0074] Affixed to the nose assembly's distal side 744 is the proximalend 762 of a generally cylindrical outer tube 76, which has alongitudinal bore 766 that extends from the proximal end 762 to thedistal end 764. Tube 76 may be removable affixed to the nose assembly topermit different sizes and configurations of outer tube 76 to be usedwith delivery device 70. Alternatively, outer tube 76 may include twocomponents (not shown) with the distal section removably attached to theproximal section such that alternative configurations and dimensions ofthe distal section can be attached to accommodate various anchorconfigurations and cable diameters. Bore 766 is dimensioned to permitthe inner tube 73 to pass therethrough and the anchor proximal portion310 to slide thereinto. In a preferred embodiment for use with theanchor of FIG. 3, bore 766 is dimensioned to prevent the anchor's distalportion 317 from passing thereinto. This bore 766 is in communicationwith the nose assembly bore 746. The outer tube 76 preferably hassufficient rigidity to pass through the tissue to be anchored.

[0075] The delivery device 70 additionally comprises a pawl 77 that hasa longitudinal bore 776 that extends from a proximal side 772 to adistal side 774 and is dimensioned to permit the cable 20 to passtherethrough. The pawl 77 is dimensioned so that its lower portion fitswithin the pawl cavity 758 and is pivotally attached adjacent a lowerproximal corner 759 thereto, at a position lower than the longitudinalbore 756. The pawl 77 is pivotable within the pawl housing cavity 758between a first position against the pawl housing cavity distal side 761and a second position against the pawl housing cavity proximal side 763.

[0076] The pawl longitudinal bore 776 is positioned in communicationwith the pawl housing bore 756 when the pawl 77 is in the first positionthereby allowing cable 20 to pass freely therethrough. When the pawl 77is in the second position, however, the bore 776 is positionedsufficiently off-axis to pinch the cable 20 and thereby prevent alongitudinal movement of the cable 20. Thus, placing the pawl 77 in thesecond position also serves to restrain the cable 20 from longitudinalmovement.

[0077] The pawl 77 also has a spring bore 777 that extends from thedistal side 774 in a proximal direction, but does not extend all the waythrough to the proximal side 772. A pawl spring 78 is affixed to thenose assembly's proximal side 742 and extends through the pawl housingspring bore 757 and into the pawl spring bore 777 to bear against thepawl 77. This spring 78 thus positioned biases the pawl 77 into thesecond position, which releasably exerts a longitudinal force on thecable 20 in a proximal direction and by the spring force exerted on pawl77 biases inner tube 73 to the second position.

[0078] The delivery device member 70 elements are relatively dimensionedso that a sliding of the inner tube 73 within the outer tube 76 may beaccomplished in a longitudinal direction between two positions. In thefirst position, the inner tube distal end 734 is in spaced relation tothe anchor proximal end 304 when the anchor proximal portion 310 iswithin the outer tube bore 766. In the second position, the inner tubedistal end 734 extends to the outer tube distal end 764, which pushesthe anchor proximal portion 310 out of the outer tube 76. As has beenseen above this ejection of the anchor proximal portion 310 permits theanchor 30 to flip from its first position to its second position,wherein it can anchor the cable 20 from being pulled in a proximaldirection. Spring 78 biases the Pawl housing 75 into the first position.

[0079] Referring now to FIG. 6, a further embodiment of an anchordelivery device according to the present invention is shown. Deliverydevice 800 has an outer tube 810 including a series of external threads836 adjacent the distal end that threadedly engage correspondinginternal threads 834 to hold outer tube 810 to nose cone 834. Inner tube812 is slidable within outer tube 810 by a mechanism within housing 814and controlled between a retracted position with distal end 813 spacedfrom distal end 811 and an extended position with distal end 813substantially adjacent distal end 811. Specifically, inner tube 812abuttingly engages plunger 830 which is biased to a retracted positionby spring 832.

[0080] As with previously described embodiments, outer tube 810 is sizedto receive at least a portion of anchor 30 while inner tube 812 is sizedto prevent passage of an anchor such as that shown in FIG. 2. Thus, whentension is applied to a cable (not shown) connected to an anchor (notshown) positioned adjacent distal end 813, the anchor forces inner tube812 against plunger 830. The cable extends through aperture 824 inplunger 816. As shown in FIG. 6, plunger 816 is biased into a lockedposition by spring 822. In this position the cable is securely held inaperture 824 to prevent movement. Thus, tension applied to the cable maybe maintained in the locked position. Movement of plunger 816 in thedirection of arrow 850 into an unlocked position releases the cable.

[0081] Movement of plunger 830 is controlled by plunger 818 throughlever 826. Movement of plunger 818 in the direction of of arrow 860moves lever 826 about pivot pin 828 to force the lever against plunger830 to overcome spring 832 and move plunger 830 against inner tube 812.This movement moves the anchor out of outer tube 810 and permitsmovement to an anchoring position. In a preferred embodiment, plunger816 includes a slot (shown in dashed lines) 820 sized to receive adistal portion 819 of plunger 818. In the locked position, shown in FIG.6, plunger 816 blocks movement of plunger 818 and thus preventsaccidental deployment of the anchor. When plunger 816 is moved in thedirection of arrow 850, slot 820 is aligned with plunger 818 such thatdistal end 819 may move into slot 820.

[0082] Crimping Tool

[0083] The present invention further contemplates a crimping tool forattachment of an anchor to a cable, suture or other elongated member. Itbeing understood that alternative crimping devices may be used to secureanchors to the above described system and that the crimping tooldescribed below may be used or adapted for use with a variety of cablingand suturing systems. The crimping tool of the present system isdesirable for the ability to crimp along the axis of a cable at arelatively distant site through a small incision.

[0084] Referring now to FIG. 13, crimping tool 50 of the presentinvention provides several advantages, including a capability ofcrimping along the longitudinal axis of the cable 20 and of cutting andcrimping in one motion. Alternatively, cutting and crimping could beperformed separately or by two separate tools with similar function andoperation to the single tool shown. The crimping tool 50 comprises anouter elongated generally cylindrical member 52 having a bore 521 from aproximal end 524 to a distal end 522. A first crimping handle 528 isaffixed to and extends radially outward from the outer member's proximalend 524.

[0085] The crimping tool 50 additionally comprises an inner elongatedgenerally cylindrical member 54 having a bore 541 dimensioned to permitcable 20 to pass therethrough. The inner cylindrical member 54 isdimensioned to fit within the outer cylindrical member's bore 521 and tobe rotatable relatively thereto about a common longitudinal axis. Asecond crimping handle 548 is affixed to and extends radially outwardfrom the inner member's proximal end 544, which extends proximal of theouter member's proximal end 524.

[0086] The handles 528 and 548 are rotatable between a first, openposition wherein the respective distal ends 529 and 549 are spaced apartby approximately 90 degrees to a second, crimping position wherein thedistal ends 529, 549 are generally opposed. Movement of handles 528 and548 causes-inner member 54 and outer member 52 to rotate with respect toeach other.

[0087] The crimping means of the crimping tool 50 is illustrated in FIG.14A, which shows the distal end 502 of the tool 50. The distal end 522of the outer member 52 has a roughly half-moon-shaped solid portion 525that obscures approximately half of the bore 541. A protrusion 526positioned in spaced relation to the longitudinal axis extends radiallytoward the opening leading to the bore 541.

[0088] The distal end 542 of the inner member 54 has a solid portion 545that obscures the remaining portion of the bore 541 except for abi-level stepped opening thereinto. Along the distal most portion is afirst roughly semicircular cutout 552 dimensioned, together with theouter member's solid portion 525, to closely surround a ferrule 94therein when the handles 528, 548 are in the open position. The outermember's protrusion 526 is positioned adjacent the cutout 552 when thehandles 528, 548 are in the-open position.

[0089] Longitudinally adjacent to and proximal of the solid portion 545is a second roughly semicircular cutout 554 dimensioned to permit thecable 20 to freely slide therethrough but too small to permit theferrule 94 to pass thereinto. When the handles 528, 548 are moved intothe crimping position, the first cutout 552 is rotated toward the solidportion 525 and protrusion 526, and a ferrule 94 residing therein iscrimped onto the cable 20.

[0090] It can be seen that the tool 50 provides the advantage ofcrimping the ferrule 94 along the longitudinal axis of the cable 20,rather than at a right angle thereto, such as is common in the art,which permits the procedure to be accomplished through a small unitaryincision without removing surrounding tissue.

[0091] Although a preferred embodiment of the crimping tool of thepresent invention is shown for use with cable 20 and ferrule 94, it iscontemplated that the device may be sized for a specific application.Moreover, it is contemplated that inner member 54 and outer member 52may have removable distal portions. A variety of sizes andconfigurations of distal portions may be interchangeable to fit avariety of flexible member and crimp configurations and types. It iscontemplated that the cabling, crimp and crimping distal portions may bepackaged as a unit to ensure proper use-by the end user with a standardcrimping tool 50.

[0092] Means are also provided for applying longitudinal tension in aproximal direction relative to the tissue to be repaired. Many devicesare know for providing tension to a cable, however, many require aseries of pulleys or other change of direction to accomplish the desiredtensioning.

[0093] In one embodiment (FIG. 13) the inner cylindrical member 54 hasan externally threaded proximal portion 550. A generally cylindricaltensioner 56 has a longitudinal bore 561 therethrough from a proximalend 564 to a distal end 562 that is adapted to be mateable with theinner cylindrical member's threaded proximal portion 550. A handle 565is affixed in radially protruding relation to the tensioner 56 exteriorfor facilitating a rotation thereof.

[0094] The cable-affixing means comprises a cleat 51 positioned adjacentto the tensioner's proximal end 564. The cleat 51, which is analogous tosuch devices known in the art, is adapted to clamp the cable's proximalend 204 to restrain the cable 20 from moving in a longitudinal directionrelative to the inner cylindrical member 54 when in a tightenedposition. When in a releasing position, the cleat 51 permits the cable20 to slide there past.

[0095] The cable-pulling means comprises the tensioner 56 and the innercylindrical member proximal end 544, which are relatively movable via ascrewing motion therebetween, which serves to change the tension on thecable 20. For example, in use the inner cylindrical member 54 andtensioner 56 are mated, and a cable 20 is inserted through the innercylindrical member bore 541 and through the tensioner bore 561, and aproximal portion of the cable is clamped by tightening the cleat 51.Unscrewing the tensioner 56 relative to the inner cylindrical member 54serves to pull the cable 20 in a proximal direction, increasing thetension thereon. The nut could be urged to prevent twisting of cable 20.

[0096] A cutting mechanism is also provided within the tool 50 whereby,when the handles 528, 548 are moved from the open to the crimpingposition, the cable 20 is cut at a location proximal to or through theferrule 94. Referring to FIG. 14B, the cutting mechanism comprises twojaws 527, 547, respectively, affixed within the bores 521, 541 of theouter cylindrical member 52 and the inner cylindrical member 54, and areplaced into opposition when the arms 528, 548 are closed, cutting thecable 20.

[0097] In a particular embodiment the ferrule 94 is typically formed ofa metal, such as stainless steel, titanium, or cobalt-chrome alloy.However, in an alternate embodiment the ferrule 94 may be made of aresorbable or non-resorbable polymer material.

[0098] The tensioning mechanism shown in FIG. 13 may be replaced withthe alternative tensioning mechanism of FIG. 15. The alternativetensioning mechanism 590 attaches to the distal end 584 of the innermember 54. Outer tube 575 is positioned about distal end 584 with spring577 positioned between the distal end and internal shoulder 585. Innermember 54 includes at least one slot 582 adapted to receive a retainingpin 581 to slidably connect the tensioning mechanism 590. Also disposedon the outer surface of distal end 584 are a series of grooves 583 orother markings to indicate the position of the outer tube 575 withrespect to inner member 54. Inner tube 586 includes a cleat 574pivotally mounted thereon by pivot pin 576. Cleat 574 pivots between aclamping position clamping a cable positioned in channel 580 and anon-clamping position, and extends through slot 578 in the outer tube.Inner tube 586 further includes an externally threaded portion 579. Ahandle 570 having an internally threaded bore is pivotably mounted onouter tube 575 and is held in place by retaining spring 572. Rotation ofhandle 571 urges outer tube 575 against spring 577, thereby tensioning acable (not shown) disposed within channel 580. It will be understoodthat the tension applied to a cable may be estimated by calibrating thespring force applied as outer tube 575 is adjacent each index marking583.

[0099] A further embodiment of a tensioning, crimping and cutting toolaccording to the present invention is disclosed in FIG. 15. The crimpingtool 900 includes an outer tube 902 attached to a nose 904. This nose isattached to a front housing 922 which is interconnected with rearhousing 924. As shown in the partial cross-section view of FIG. 16,inner tube 901 is disposed within outer tube 902 and includes a bore 917for receiving cable 908. The position of cable 908 within inner tube 901is maintained with respect to movement toward the distal end 905 bytrigger pawl 906. Trigger pawl 906 is pivotally connected to fronthousing 922 by pivot pin 939. As shown in FIG. 16, spring 938 biasestrigger pawl 906 into the cable retaining position with engaging end 907engaging cable 908 adjacent the proximal end of inner tube 901. Triggerpawl 906 may be moved to a disengaged position by overcoming the forceof spring 938 and moving trigger pawl 906 within slot 940 such thatengaging end 907 disengages cable 908.

[0100] Rear housing 924 includes a cable tensioner assembly 926 forapplying tension to cable 908 towards the proximal end 913. Tensioningassembly 926 is operable between a tensioning position and the releasedposition shown in FIG. 16, by movement of handle 910 with respect tohandle 912. Handle 910 is pivotally attached to rear housing 924 bypivot pin 918. A linking bar 915 is joined to handle 910 by pivot pin916 and interconnects the handle with tensioning assembly 926 throughpivot pin 924. Movement of handle 910 towards handle 912, fixedlyconnected to rear housing 924, causes tensioning assembly 926 to moveproximally.

[0101] Referring now to FIG. 16, tensioning assembly 926 includes a pairof pawls that grip cable 908 when tensioning assembly 926 is displacedproximally and that allow passage of the cable when tensioning assemblyis moving distally. Pawl 941 is pivotally connected to the tensioningassembly 926 by pivot pin 942. The pawl is urged into a locking positionby spring 943. The pawl opposing pawl 941 is identical. Tensioningassembly 926 further includes a set of belleville springs 944 that maybe adjusted by movement of threaded shaft 945 to increase or decreasethe pressure applied to the cable when the gripping teeth of the pawlsare disengaged with the wire as the tensioning assembly is drawnforward. Springs 944 maintain the position of pin 924 within slot 932.Spring 914 disposed between handles 910 and 912 in openings 928 and 930respectively, urges handle 910 forward. This movement also urgestensioning assembly pawls against front wall 937 which in turn urges thepawls into a disengaged position shown in FIG. 16.

[0102] In operation, tensioning assembly 926 is moved to apply proximaltension to cable 908. As previously described, trigger pawl 906 permitsproximal movement of the cable. Once proximal tension is released by thetensioning assembly, trigger pawl 906 engages cable 908 to preventdistal movement and thereby maintain the tension while the pawls of thetensioning assembly are disengaged to permit the assembly to return to aforward position. This process may be continued until the desired amountof cable tension has been achieved.

[0103] Cable tensioner, crimper and cutter 900 also includes crimpingand cutting handles 934 and 936. Referring to FIG. 17, handle 936 isfixedly attached to rear housing 924 while handle 924 is connected bypivot pin 946 to front housing 922. The handles are biased into aseparated position by spring 949 mounted on projection 950 of handle 934and received within opening 951 in the rear housing. Handle 934 includesa slot 948 for receiving an inner tube extension 947 (FIG. 16). Linearmovement of handle 934 toward handle 936 is translated into rotation ofinner tube 901 by the engagement of inner tube extension 947 in slot948. The distal end 905 of inner and outer tubes 901 and 902 areconfigured as shown in FIGS. 14A and 14B such that rotation of the innertube in relation to the outer tube results in crimping a ferrule andcutting a cable.

[0104] Still a further embodiment of a tensioning, crimping and cuttingtool according to the present invention relies on longitudinal movementof the components rather than rotational movement. Referring to FIG. 18,a tensioning, crimping and cutting tool 955 includes an inner member959, an outer member 958 and a cable retaining assembly 975. Cableretaining assembly 975 is preferably received within inner member 959and includes a cleat 977 pivotally mounted to be moveable between adisengaged position and an engaged position securely holding cable 956.Retaining assembly 975 further includes a threaded section 976. Innermember 959 includes a flange 972. An internally threaded nut 973 isdisposed about flange 972 and engages threaded section 976. Nut 973 isrotatably maintained in position by mounting pins 974.

[0105] Inner member 959 includes an externally threaded section 971adjacent flange 972 and at an opposite end, a pair of spaced branches978 and 979, each having a flared section 980 and 981, respectively.Branch 978 includes a cutting blade 962 and a crimping projection 964while branch 979 includes a corresponding cutting anvil 963 and crimpingdepression 965. It is contemplated that inner member 959 may includemore than two branches and may have multiple projections disposedadjacent distal end 967.

[0106] Inner member 959 is disposed within a preferably tubular outermember 958. Outer member 958 includes an inclined surface 960 adjacentdistal end 966. Opposite the inclined surfaces is a flange 968. Nut 969is disposed about flange 968 and pivotally retained there by mountingpins 970.

[0107] In operation, cable 956, having a distal end anchored in a tissuesection (not shown), is threaded through inner member 959 and cableretaining assembly 975. A ferrule 957, slidable along cable 956, ispositioned within branches 978 and 979 adjacent crimping projection 964and crimping depression 965. Cleat 977 is rotated to engage cable 956.Nut 973 is rotated about external threads 976 to move the cableretaining assembly with respect to the inner member, which bears againsta section of tissue (not shown), and thereby applies tension to cable956. Once the desired amount of tension is applied, nut 969 is rotatedwith respect to threads 971 to urge outer member 958 downward towardferrule 957. As outer member 958 advances, branches 978 and 979 areurged toward each other by acting against inclined surface 960. Thus,cutting blade 962 and cutting anvil 963 cooperate to cut cable 956 whilecrimping projection 964 and crimping depression 965 crimp ferrule 957 tosecurely engage cable 956.

[0108] While threaded engagements have been illustrated for applyingcable tension and for moving the outer member, it is contemplated thatother mechanisms known to those skilled in the art may be applied to thedevice described herein. Moreover, nut 973 may be engaged by a torquewrench to provide the user with an estimate of the tension applied tocable 956. Variations of the present longitudinal crimping tool arewithin the spirit of the present invention, such tools utilizingmovement preferably occurring within the outer tube such that theopening in the tissue is not significantly enlarged beyond the diameterof the outer tube as a result of the crimping process.

[0109] Alternative Anchor Embodiments

[0110] An alternate form of a tissue anchor comprises an eyelet anchor32, the structure and function of which are illustrated in FIGS. 9 and10. The eyelet anchor 32 is affixed at a proximal end 324 to the cabledistal end 202, and the eyelet anchor 32 has an eyelet hole 321 at adistal end 322 for receiving an anchoring screw 79. The eyelet anchor 32also has a cable bore 323 adjacent the proximal end 324 adapted topermit cable 20 to pass therethrough and to be crimped therein.

[0111] The delivery devices of FIGS. 1, 4 or 6 are also usable with theeyelet anchor 32 described above. In this case, the eyelet anchor 32 hasa central portion 325 that is dimensioned larger than the distal portionof the delivery device member cylindrical portion bore 401 or 766. Theeyelet anchor 32 further has a proximal portion 326 that is dimensionedto reside within the distal portion of the delivery device membercylindrical portion bore 401 or 766. Thus, as above, the eyelet anchorproximal portion 326 is retainable within the bore 401 or 766 when thecable 20 to which it is attached is under longitudinal tension in aproximal direction. Alternatively, it is contemplated that eyelet anchor32 is formed of a deformable material which tends to resume its originalshape. It will be understood that an eyelet anchor 32 formed of such amaterial may be deformed to be received within outer tube 76, such thatinner tube 73 will force eyelet anchor 32 out of outer tube 76. Theanchor may then resume its larger original dimensions.

[0112] The present invention also contemplates the use of a bone openingprotector 150 as shown in FIGS. 10 and 11. Opening protector includes asurface engaging portion 152 adapted to engage the exterior surface ofthe bone adjacent the opening to prevent advancement into the bone.Opening protector 150 also includes a cylindrical portion 151 thatextends into the bone opening and provides a lumen for passage of cable20. Preferably, the exterior surface of the cylindrical portion 151includes a roughened surface to engage the surrounding bone to preventdislogdement. While it is contemplated that the roughened surface may bethreads such that the protector may be screwed into the opening,preferably, the surface includes a series of circular projections 153having an inclined leading edge for ease of insertion and a cavityadjacent the trailing edge to inhibit removal. Also, it is contemplatedthat cylindrical portion 151 could be substantially eliminated andanchoring elements could extend through, or be a part of, surfaceengaging portion 152.

[0113] It is intended that the surface engaging position 152 liesubstantially flush with the surface of the bone. Thus, for openingscreated perpendicular to the surface of the bone, cylindrical portion151 and surface engaging portion 152 will be perpendicular. In apreferred embodiment, the corner 154 between the cylindrical portion 151and surface engagement portion 152 is rounded. This is intended to limitthe abrasion and wear on the anchoring member as it slides across thecorner. The protector is particularly useful in applications were thecable or suture will be pulled against the corner of the bone opening.As shown in FIG. 10, eyelet anchor 32 secured by bone screw 79 and cable20 extends through opening protector 150. Tension is applied to cable 20and is maintained by crimped ferrule 94 bearing against washer 14.Without opening protector 150, cable 20 would have a tendency to cutthrough the edge of the bone opening causing damage to surroundingtissue and reducing the tension on cable 20.

[0114] Tissue Anchoring Method

[0115] The method for utilizing the above-described system comprises thefollowing steps, as shown in FIGS. 12A-E, for anchoring two sections ofbone together. It is obvious to one skilled in the art that the sametechnique is applicable to a method for anchoring two different bonestogether, for anchoring other types of tissue together, or for anchoringanother type of tissue to bone [see, e.g., FIG. 8, illustrating theanchoring of a ligament 92 (here, a medial collateral ligament) to abone 90 (here, the tibia)]. Therefore, no limitations are intended bythe presentation of this exemplary embodiment.

[0116] Two holes 115 and 116 are drilled through the bone sections 90and 91, the cable/anchor/delivery device 20/30/40 combination isinserted through the holes 115, 116 until the anchor 30 is completelythrough the distal hole 115 (FIG. 12A). Although drilled holes areillustrated, it is contemplated that anchor 30 may include a sharp tipsuch that the anchor may be pushed through unprepared bone or othertissue. The cable tension is released, which permits the anchor 30 torotate and be restrained on the distal side of the distal hole 115 (FIG.12B). In addition to the anchor disclosed herein, it is contemplatedthat the insertion device could also be used with an anchor designed tobe embedded within the bone, i.e. the anchor would not exit the distalcortical bone and instead would be deployed in the cancellous bone.

[0117] The delivery device 30 is removed from the cable 20, and a washer93 and ferrule 94 are threaded onto the cable to a position adjacent theproximal hole 912 (FIG. 12C). The cable 20 is then inserted into thecrimping tool 50 sufficiently far that the ferrule 94 is positionedwithin the first cutout 552 adjacent the second cutout 554. The cable 20is clamped with the cleat 51 and pulled to a desired tension (FIG. 12D).Tensioner 56 may be unscrewed with respect to inner cylindrical member54 while cleat 51 securely holds cable 20, thereby pulling the bonefragments together and applying measurable compression between thefragments. The crimping tool 50 is closed to crimp the ferrule 94 ontothe cable 20 and also to cut the cable 2-0 (FIG. 12E). Alternatively,the crimp may be made first, and then a separate cable cutting tool (notshown) can be used for thicker types of cable.

[0118] If desired, an eyelet anchor 60, such as shown in FIGS. 9, mayalso be used. In this case, the eyelet anchor 60 is threaded onto thecable 20 via cable bore 602, which is at the proximal end 601, beforethe ferrule 94 is threaded on, and, after the crimp is made, a screw 61is inserted through the screw hole 604, which forms the eyelet, and intothe bone 90 to attach the eyelet anchor 60 (FIG. 9).

[0119] The method described above may be performed utilizing anycombination of the delivery devices and tensioning, crimping and cuttingtools described herein.

[0120] Suture Material Anchoring System and Method

[0121] A suture material anchor system 83, as shown in FIG. 7A forrepairing soft tissue, comprises a suture anchor 84 for use with adelivery device, such as either of the delivery devices 40, 70 or 800 asdescribed above.

[0122] The suture anchor 84 is an elongated member having a longitudinalaxis extending from a proximal end 844 to a distal end 842. The sutureanchor 84 also has a pair 845, 846 of cross-bores extending from a firstside 847 through to a second, opposed side 848. Cross-bores 845, 846 aredimensioned to permit suture material 86 to pass therethrough. In usesuture material 86 is threaded through bore 845 from the first side 847to the second side 848 and then through the other bore 846 from thesecond side 848 to the first side 847.

[0123] The suture anchor 84 has a narrowed proximal portion 843 at theproximal end 844, proximal of the cross-bores 845, 846, that isdimensioned to be insertable into and supported by the impeller bore 401or the outer tube bore 766, as previously described for the pivotableanchor 30. The central portion 848 is dimensioned too large to beinsertable into the impeller bore 401 or the outer tube bore 766. Thesuture anchor 84 has a first cross-sectional dimension generally alongthe longitudinal axis greater than a second cross-sectionaldimension-generally perpendicular to the longitudinal axis, as beforefor the pivotable anchor 30.

[0124] The suture anchor 84 is manipulable and pivotable by pulling theends of the suture material, which can accomplish a bracing of thesuture anchor 84 against the distal side of the tissue 85 to berepaired. In use, the ends of the suture material 86 are retainableoutside the incision, or, alternatively, one end 862 can be retainedoutside the introducing incision 88, and a second end 864 can be pulledthrough a second incision 89, as shown in FIG. 7B.

[0125] A method of using the system 83 to repair a soft tissue tear suchas a meniscal tear T comprises the steps of piercing the tissue 85across the tear T, inserting the delivery device/suture material/anchorsystem into the pierced hole 834, manipulating the delivery device sothat the anchor 84 emerges from the far end of the tear T and rotates sothat the anchor 84 has its length generally perpendicular to the tear Tand thus will not slip out. The surgeon can then manipulate the suturematerial 86 and tie it off as desired to secure the repair.Alternatively, a second incision 835 may be made at an adjacent siteacross the tear T, as shown in FIG. 7B, and the two pieces of suturematerial then joined together to strengthen the repair. The anchor 84can either be inserted into the body of the tissue 84, as shown in FIG.7B, or it can be impelled completely through the tissue (not shown),depending upon the application, to anchor the suture material 86.

[0126] While the invention has been illustrated and described in detailin the drawings and foregoing description, the same is to be consideredas illustrative and not restrictive in character, it being understoodthat only the preferred embodiments have been shown and described andthat all changes and modifications that come within the spirit of theinvention are desired to be protected.

What is claimed is:
 1. A method for attaching a first section of tissueto a second section of tissue, the method comprising the steps of:providing an anchor member having a first dimension larger than a seconddimension, the anchor member affixed to a first end of a cable;inserting the anchor member in combination with the cable into a bore ofa delivery device, the bore having a longitudinal axis, a distal end ofthe anchor member retained outside the delivery device bore, a proximalend of the anchor member inserted into and supported by the bore of thedelivery device; maintaining tension on the cable within the deliverydevice to retain the anchor member proximal end within the deliverydevice bore and to maintain the first dimension in alignment with thelongitudinal axis; impelling the anchor member in combination with theinsertion device through the first tissue section and then through thesecond tissue section; releasing the tension on the cable; pivoting theanchor member to a position wherein the anchor member first dimension isgenerally transverse to the bore longitudinal axis; applying tension toa second end of the cable to force the anchor against a distal side ofthe second tissue section and to urge the first tissue section intoclose opposition with the second tissue section; affixing a retainer tothe cable adjacent a proximal side of the first tissue section; andcutting the cable proximal the retainer.
 2. The method of claim 1,wherein the first section of tissue and the second section of tissueincludes cortical bone.
 3. The method of claim 2, wherein the anchormember is a rigid material sufficient to withstand the force applied tocompress a fracture between the first cortical bone section and thesecond cortical bone section.
 4. The method of claim 3, wherein theanchor member is stainless steel.
 5. The method of claim 3, wherein thecable has sufficient tensile strength to withstand the force applied tocompress a fracture between the first bone segment and the second bonesegment.
 6. The method of claim 5, wherein the cable is medical gradesteel.
 7. The method of claim 1, wherein said affixing is performed bydeforming a portion of the retainer to engage the cable.
 8. The methodof claim 7, wherein the method is performed through a unitary incisionin the human body.
 9. The method of claim 7, further including:providing a crimping and tensioning tool having an outer member andinner member movably disposed within the outer member; sliding aretainer on the cable after said pivoting step; inserting the cable intothe crimping and tension tool outer member; performing said applyingtension step utilizing the crimping and tensioning tool to urge theretainer toward the anchor member; and moving the inner member withrespect to the outer member thereby deforming a portion of the retainer.10. A method for joining two segments of tissue, comprising; providing afirst anchor, an elongated member attached to the first anchor, a secondanchor slidable on the elongated member and having a deformable portionadapted to engage the elongated member, and a crimping tool having anouter member and an inner member movably disposed within the outermember; inserting the elongated member through a proximal tissue segmentand a distal tissue segment; anchoring the first anchor to the distaltissue segment; sliding the second anchor on the elongated memberadjacent the proximal tissue segment; threading the elongated memberthrough the crimping device; applying tension on the elongated member tourge the distal tissue segment toward the proximal tissue segment; andmoving the inner member with respect to the outer member therebydeforming the deformable portion of the second anchor and maintainingthe tension applied to the elongated member.
 11. The method of claim 10,wherein the two segments of tissue include cortical bone.
 12. The methodof claim 11, wherein the anchor is at least as rigid as cortical boneand the elongated member is more flexible than cortical bone.
 13. Themethod of claim 12, wherein the anchor is pivotable relative to theelongated member between a first position wherein a longitudinal axis ofthe first anchor is in substantial alignment with a longitudinal axis ofthe elongated member, and a second position wherein the longitudinalaxis of the first anchor is substantially transverse to the longitudinalaxis of the elongated member; said inserting including inserting thefirst anchor through the proximal and distal tissue segments in thefirst position and said anchoring includes pivoting the first anchorinto the second position.
 14. The method of claim 13, further includingpositioning a washer on the elongated member prior to said sliding. 15.The method of claim 11, further including positioning a bone openingprotector adjacent to the proximal tissue segment prior to said slidingto inhibit the elongated member or second anchor from cutting into thebone.
 16. The method of claim 10, wherein said moving is rotating saidinner member with respect to said outer member.
 17. The method of claim10, wherein the crimping tool includes a tensioning apparatus and acutting apparatus, and said applying tension includes operating thetension apparatus to exert tension on the elongated member and furtherincluding operating the cutting apparatus to cut the elongated memberadjacent the second anchor.
 18. A method for joining two cortical bonesegments, comprising: providing a first rigid anchor pivotally connectedto an elongated flexible member, the first rigid anchor moveable betweenan insertion position wherein a longitudinal axis of the first anchor isin substantial alignment with a longitudinal axis of the elongatedflexible member, and an anchor position wherein the longitudinal axis ofthe first rigid anchor is substantially transverse to the longitudinalaxis of the elongated member, a second deformable anchor slidable alongthe elongated flexible member, an insertion device adapted to hold aportion of the first anchor, and a tensioning and crimping tool havingan outer elongated member and an inner member movably disposed withinthe outer member; inserting a portion of the elongated member into theinsertion device; interconnecting a portion of the first rigid anchorand the insertion device; impelling the insertion device withinterconnected first rigid anchor through the first and second corticalbone segments; pivoting the first rigid anchor with respect to theinsertion device to the anchor position; sliding the second deformableanchor on the elongated member adjacent the proximal tissue segment;threading the elongated member through the tensioning and crimping tool;applying tension on the elongated member to urge the first rigid anchortoward the second deformable anchor thereby urging the first corticalbone segment toward the second cortical bone segment; and moving theinner member with respect to the outer member thereby deforming thedeformable portion of the second deformable anchor and maintaining thetension applied to the elongated member.
 19. The method of claim 18,wherein said insertion device is adapted to releasably engage theelongated member, further including applying tension to the elongatedmember after said interconnecting and releasably engaging the elongatedmember with the insertion device to thereby hold the first rigid anchorin alignment with the insertion device.
 20. The method of claim 18,wherein the tensioning and crimping tool includes a cutting mechanism,further including operating the cutting mechanism to cut the elongatedmember adjacent the second deformable anchor.
 21. The method of claim20, wherein the cutting mechanism is disposed adjacent the seconddeformable anchor and cuts a portion of the second deformable anchorduring said operating.